Effects of Phenobarbital and Levetiracetam on PR and QTc Intervals in Patients with Post-Stroke Seizure

Siniscalchi, Antonio; Scaglione, Francesco; Sanzaro, Enzo; Iemolo, Francesco; Albertini, G.; Quirino, Gianluca; Manes, Maria Teresa; Gratteri, Santo; Mercuri, Nicola Biagio; Sarro, Giovambattista De; Gallelli, Luca

doi:10.1007/s40261-014-0243-9

Cited by 15 publications

(8 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these, 10,455 records were excluded after LEV search and title/abstract screening and 162 reports were eligible for full-text review. After full-text review, we included 142 reports: 30 SRs/meta-analyses,22–51 34 RCTs,52–85 18 observational studies,86–103 58 case reports104–161 and 2 economic studies162,163 (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…Outcome measures included seizure freedom, 50% responder rate, reduction in seizure frequency, neuropsychological findings, congenital malformation, serious AEs, total AEs, single AEs and other outcomes (Figure 2A). Among the included RCTs, 12 compared LEV with placebo,52,55,56,58,60–63,65,66,68,78 9 compared LEV with CBZ,53,69,70,73,74,79–82 4 compared LEV with lamotrigine (LTG),57,64,71,81 3 compared LEV with phenobarbital (PB),64,75,85 3 compared LEV with VPA,70,74,82 2 compared LEV with oxcarbazepine (OXC),54,83 2 compared LEV with sulthiame,72,84 1 compared LEV with pregabalin,77 1 compared LEV with phenytoin59 and 1 compared LEV with topiramate 67. Outcome measures included seizure freedom, 50% responder rate, reduction in seizure frequency, QoL, serious AEs, total AEs, single AEs and other outcomes (Figure 2B).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles

Zhang

Wen

Cai

et al. 2018

NDT

View full text Add to dashboard Cite

ObjectiveTo evaluate the efficacy, safety and economics of levetiracetam (LEV) for epilepsy.Materials and methodsPubMed, Scopus, the Cochrane Library, OpenGrey.eu and ClinicalTrials.gov were searched for systematic reviews (SRs), meta-analyses, randomized controlled trials (RCTs), observational studies, case reports and economic studies published from January 2007 to April 2018. We used a bubble plot to graphically display information of included studies and conducted meta-analyses to quantitatively synthesize the evidence.ResultsA total of 14,803 records were obtained. We included 30 SRs/meta-analyses, 34 RCTs, 18 observational studies, 58 case reports and 2 economic studies after the screening process. The included SRs enrolled patients with pediatric epilepsy, epilepsy in pregnancy, focal epilepsy, generalized epilepsy and refractory focal epilepsy. Meta-analysis of the included RCTs indicated that LEV was as effective as carbamazepine (CBZ; treatment for 6 months: 58.9% vs 64.8%, OR=0.76, 95% CI: 0.50–1.16; 12 months: 54.9% vs 55.5%, OR=1.24, 95% CI: 0.79–1.93), oxcarbazepine (57.7% vs 59.8%, OR=1.34, 95% CI: 0.34–5.23), phenobarbital (50.0% vs 50.9%, OR=1.20, 95% CI: 0.51–2.82) and lamotrigine (LTG; 61.5% vs 57.7%, OR=1.22, 95% CI: 0.90–1.66). SRs and observational studies indicated a low malformation rate and intrauterine death rate for pregnant women, as well as low risk of cognitive side effects. But psychiatric and behavioral side effects could not be ruled out. LEV decreased discontinuation due to adverse events compared with CBZ (OR=0.52, 95% CI: 0.41–0.65), while no difference was found when LEV was compared with placebo and LTG. Two cost-effectiveness evaluations for refractory epilepsy with decision-tree model showed US$ 76.18 per seizure-free day gained in Canada and US$ 44 per seizure-free day gained in Korea.ConclusionLEV is as effective as CBZ, oxcarbazepine, phenobarbital and LTG and has an advantage for pregnant women and in cognitive functions. Limited evidence supports its cost-effectiveness.Registered numberPROSPERO (No CRD 42017069367).

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles

Zhang

Wen

Cai

et al. 2018

NDT

View full text Add to dashboard Cite

show abstract

“…Several medications may also prolong the QTc interval [31,32]. The included patients were sedated using continuous propofol and fentanyl infusion, and both drugs may affect the QTc interval.…”

Section: Discussionmentioning

confidence: 99%

Suppression of Electrographic Seizures Is Associated with Amelioration of QTc Interval Prolongation in Patients with Traumatic Brain Injury

Dąbrowski

Siwicka-Gieroba

Schlegel

et al. 2021

JCM

View full text Add to dashboard Cite

Introduction: Disorders in electroencephalography (EEG) are commonly noted in patients with traumatic brain injury (TBI) and may be associated with electrocardiographic disturbances. Electrographic seizures (ESz) are the most common features in these patients. This study aimed to explore the relationship between ESz and possible changes in QTc interval and spatial QRS-T angle both during ESz and after ESz resolution. Methods: Adult patients with TBI were studied. Surface 12-lead ECGs were recorded using a Cardiax device during ESz events and 15 min after their effective suppression using barbiturate infusion. The ESz events were diagnosed using Masimo Root or bispectral index (BIS) devices. Results: Of the 348 patients considered for possible inclusion, ESz were noted in 72, with ECG being recorded in 21. Prolonged QTc was noted during ESz but significantly ameliorated after ESz suppression (540.19 ± 60.68 ms vs. 478.67 ± 38.52 ms, p < 0.001). The spatial QRS-T angle was comparable during ESz and after treatment. Regional cerebral oximetry increased following ESz suppression (from 58.4% ± 6.2 to 60.5% ± 4.2 (p < 0.01) and from 58.2% ± 7.2 to 60.8% ± 4.8 (p < 0.05) in the left and right hemispheres, respectively). Conclusion: QTc interval prolongation occurs during ESz events in TBI patients but both it and regional cerebral oximetry are improved after suppression of seizures.

show abstract

“…[678] In poststroke seizure patients aged more than 18 years old, the antiepileptic drugs (phenobarbital, levetiracetam) may be the cause of significant prolongation of QT interval during interictal phase compared with control. [9] Expression of the neuronal sodium channel (Nav1.1) is increased in rat heart using the experimental animal model of epilepsy[10] and QT-prolongation were observed in the kindling of the hippocampus region. [11]…”

Section: Introductionmentioning

confidence: 99%

Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots

Al-Nimer

Al-Mahdawi

Abdullah

et al. 2017

Journal of Neurosciences in Rural Practice

View full text Add to dashboard Cite

Background:Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias.Objectives:This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots.Methods:A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias.Results:Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I.Conclusion:Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

show abstract

Effects of Phenobarbital and Levetiracetam on PR and QTc Intervals in Patients with Post-Stroke Seizure

Abstract: The study reported that in patients with late post-stroke seizures, phenobarbital prolonged QTc interval more so than levetiracetam.

Cited by 15 publications

References 36 publications

Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles

Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles

Suppression of Electrographic Seizures Is Associated with Amelioration of QTc Interval Prolongation in Patients with Traumatic Brain Injury

Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots

Contact Info

Product

Resources

About